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Siddiqui S, Mehta D, Coles A, Selby P, Solmi M, Castle D. Psychosocial Interventions for Individuals With Comorbid Psychosis and Substance Use Disorders: Systematic Review and Meta-analysis of Randomized Studies. Schizophr Bull 2024:sbae101. [PMID: 38938221 DOI: 10.1093/schbul/sbae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND AND HYPOTHESIS Substance use is highly prevalent among people with schizophrenia (SCZ) and related disorders, however, there is no broad-spectrum pharmacotherapy that concurrently addresses both addiction and psychotic symptoms. Psychosocial (PS) interventions, which have yielded promising results in treating psychosis and substance dependence separately, demonstrate potential but have not been systematically evaluated when combined. STUDY DESIGN Systematic review and random-effects meta-analyses of randomized controlled trials (RCTs) investigating PS interventions for individuals with comorbid substance use and psychotic disorders, encompassing SCZ and schizophrenia spectrum disorders (SSD). We included relevant studies published from MEDLINE, PsycINFO, and Google Scholar through May 2023. STUDY RESULTS We included 35 RCTs (5176 participants total; approximately 2840 with SSD). Intervention durations ranged from 30 min to 3 years. Meta-analysis did not identify a statistically significant pooled PS intervention effect on the main primary outcome, substance use (18 studies; 803 intervention, 733 control participants; standardized mean difference, -0.05 standard deviation [SD]; 95% CI, -0.16, 0.07 SD; I2 = 18%). PS intervention effects on other outcomes were also not statistically significant. Overall GRADE certainty of evidence was low. CONCLUSIONS At present, the literature lacks sufficient evidence supporting the use of PS interventions as opposed to alternative therapeutic approaches for significantly improving substance use, symptomatology, or functioning in people with SCZ and related disorders. However, firm conclusions were precluded by low certainty of evidence. Further RCTs are needed to determine the efficacy of PS treatments for people with dual-diagnoses (DD), either alone or in combination with pharmacotherapy.
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Affiliation(s)
- Salsabil Siddiqui
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Dhvani Mehta
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | | | - Peter Selby
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, Toronto, Canada
- Institute of Mental Health Policy Research, Campbell Family Research Institute, CAMH, Toronto, Canada
- Institute of Mental Health Policy and Research, Addictions Division, Integrated Nicotine and Tobacco Research, Education, Programming, Implementation and Digital Health (INTREPID) Lab, CAMH, Toronto, Canada
| | - Marco Solmi
- SCIENCES Lab, Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Regional Centre for the Treatment of Eating Disorders and On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - David Castle
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Tasmania, Hobart, Australia
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Wojtalik JA, Brown WJ, Mesholam-Gately RI, Kotwani A, Keshavan MS, Eack SM. Predictors of treatment discontinuation during an 18-month multi-site randomized trial of Cognitive Enhancement Therapy for early course schizophrenia. Psychiatry Res 2023; 326:115254. [PMID: 37267670 PMCID: PMC10527356 DOI: 10.1016/j.psychres.2023.115254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 06/04/2023]
Abstract
Treatment discontinuation during clinical trials in schizophrenia is a critical challenge, especially for longer-term interventions in the early course. This research explored predictors of treatment discontinuation in an outpatient early course schizophrenia sample (N = 102) during an 18-month multi-site trial of Cognitive Enhancement Therapy (n = 58) and Enriched Supportive Therapy (n = 44). Fifty-three (52%) participants discontinued, with no significant difference between the treatment groups in discontinuation rate. Univariate and multivariate binary logistic regression models explored differences in key demographic and cognitive and behavioral outcomes between participants who completed and discontinued treatment. Significant multivariate predictors of discontinuation included IQ (linear) and problem solving (curvilinear). The concave shape of the problem solving prediction demonstrated that initially as scores were increasing the probability of non-completion was increasing. However, after a score of 41 (below average problem solving), the probability of being a non-completer decreased as performance increased. Non-completers had significantly lower IQ scores compared to completers. Post-hoc analyses indicated that participants who discontinued prior to mid-treatment exhibited the greatest intellectual challenges, with comparisons moderate-to-large in strength. IQ and problem solving are likely important factors to assess at pre-treatment in early course schizophrenia trials to identify those most vulnerable to discontinuation.
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Affiliation(s)
- Jessica A Wojtalik
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA.
| | - Wilson J Brown
- Department of Psychology, School of Humanities and Social Sciences, Pennsylvania State University, The Behrend College, Erie, PA, USA
| | - Raquelle I Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Anju Kotwani
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Shaun M Eack
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USW; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Whiteley L, Olsen EM, Haubrick KK, Kang C, Vaughan I, Brown LK. A Review of Digital Interventions to Decrease Cannabis Use Among Patients With Comorbid Psychiatric Disorders. J Dual Diagn 2022; 18:199-210. [PMID: 36178356 PMCID: PMC10311985 DOI: 10.1080/15504263.2022.2126058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Cannabis use disorder (CUD) is associated with an elevated risk for psychiatric disorders and symptoms, contributing to poor health outcomes and increased medical costs. Unfortunately, interventions that simultaneously address cannabis use and co-occurring psychiatric disorders are limited in availability. Targeted digital interventions to reduce cannabis use could be beneficial for patients with psychiatric disorders. Digital interventions could be easily disseminated and used in numerous clinical locations, including outpatient, inpatient, residential, and community psychiatric treatment settings. METHODS Literature on digital cannabis reduction interventions for persons with psychiatric disorders was examined between April 2021 and June 2021. Articles were obtained from PubMed and PsycINFO databases. English language randomized controlled trials (RCT), feasibility and acceptability studies, pilot studies, and published protocols were included. RESULTS There is significant evidence that digital interventions can effectively reduce cannabis use in general, non-clinical populations. However, there is less literature examining interventions for persons living with co-occurring psychiatric illness-most of which is tailored to patients living with chronic psychosis. CONCLUSIONS There is great need for accessible and tailored digital interventions for co-occurring CUD and psychiatric disorders.
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Affiliation(s)
- Laura Whiteley
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Elizabeth M. Olsen
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Kayla K. Haubrick
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Chaerim Kang
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Ian Vaughan
- American University, Washington, District of Columbia, USA
| | - Larry K. Brown
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA
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Guimond S, Ling G, Drodge J, Matheson H, Wojtalik JA, Lopez B, Collin G, Brady R, Mesholam-Gately RI, Thermenos H, Eack SM, Keshavan MS. Functional connectivity associated with improvement in emotion management after cognitive enhancement therapy in early-course schizophrenia. Psychol Med 2022; 52:2245-2254. [PMID: 33183362 PMCID: PMC10763577 DOI: 10.1017/s0033291720004110] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The ability to manage emotions is an important social-cognitive domain impaired in schizophrenia and linked to functional outcome. The goal of our study was to examine the impact of cognitive enhancement therapy (CET) on the ability to manage emotions and brain functional connectivity in early-course schizophrenia. METHODS Participants were randomly assigned to CET (n = 55) or an enriched supportive therapy (EST) control group (n = 45). The resting-state functional magnetic resonance imaging scans and measures of emotion management performances were collected at baseline, 9, and 18 months follow-up. The final sample consisted of 37 CET and 25 EST participants, including 19 CET and 12 EST participants with imaging data. Linear mixed-effects models investigated the impact of treatment on emotion management and functional connectivity from the amygdala to ventrolateral and dorsolateral prefrontal cortex (dlPFC). RESULTS The CET group showed significant improvement over time in emotion management compared to EST. Neither functional connectivity changes nor main group differences were observed following treatment. However, a significant between-group interaction showed that improved emotion management ability was associated with increased functional connectivity between the left amygdala and the left dlPFC in the CET group exclusively. CONCLUSION Our results replicate the previous work demonstrating that CET is effective at improving some aspects of social cognition in schizophrenia. We found evidence that improvement in emotion management may be associated with a change in amygdala-dlPFC connectivity. This fronto-limbic circuit may provide a mechanistic link between the biology of emotion management processes that can be enhanced in individuals with schizophrenia.
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Affiliation(s)
- Synthia Guimond
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Department of Psychiatry, The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON, K1Z 7K4, Canada
- Department of Psychoeducation and Psychology, University of Québec in Outaouais, Gatineau, QC, J8X 3X7, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, K1H 8L1, Canada
| | - George Ling
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
- University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Jessica Drodge
- Department of Psychiatry, The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON, K1Z 7K4, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, K1H 8L1, Canada
| | - Hannah Matheson
- Department of Psychiatry, The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON, K1Z 7K4, Canada
| | - Jessica A. Wojtalik
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Betzamel Lopez
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
| | - Guusje Collin
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- University Medical Center Utrecht Brain Center, 3584 XC Utrecht, The Netherlands
| | - Roscoe Brady
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Raquelle I. Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Heidi Thermenos
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Shaun M. Eack
- School of Social Work and Department of Psychiatry, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA
| | - Matcheri S. Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
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Wojtalik JA, Mesholam-Gately RI, Hogarty SS, Greenwald DP, Litschge MY, Sandoval LR, Shashidhar G, Guimond S, Keshavan MS, Eack SM. Confirmatory Efficacy of Cognitive Enhancement Therapy for Early Schizophrenia: Results From a Multisite Randomized Trial. Psychiatr Serv 2022; 73:501-509. [PMID: 34470506 PMCID: PMC8888780 DOI: 10.1176/appi.ps.202000552] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cognitive enhancement therapy (CET) is an 18-month comprehensive cognitive remediation intervention designed to improve cognition and functioning among patients with schizophrenia. The current study sought to confirm previously observed benefits of CET on cognitive and behavioral outcomes in the early course of the condition in a large multisite trial. METHODS Overall, 102 outpatients with early-course schizophrenia were randomly assigned to 18 months of CET (N=58) or enriched supportive therapy (EST; N=44). Participants completed cognitive, social adjustment, and symptom assessments at baseline and at 9 and 18 months. Composite indices were calculated for these outcomes. Mixed-effects models investigated differential changes in outcomes between CET and EST. Because of a high attrition rate, sensitivity analyses of data from treatment completers (N=49) were conducted. RESULTS The effects of CET on improved overall cognition were confirmed and tentatively confirmed for social cognition in both intent-to-treat and completer analyses, and beneficial effects on attention/vigilance were also observed. An effect of CET on social adjustment was not confirmed in the analyses, because both CET and EST groups had considerably improved social adjustment. Although not statistically significant, the between-group effect size for CET's effect on social adjustment doubled from the intent-to-treat (Cohen's d=0.23) to completer analyses (Cohen's d=0.51) (p=0.057). Both groups displayed similar symptom improvements. CONCLUSIONS CET effectively improved cognition among patients with early-course schizophrenia. The functional benefits of CET appeared to increase with treatment retention. Further research is needed to understand predictors of attrition and mechanisms of change during CET for this population.
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Affiliation(s)
- Jessica A Wojtalik
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland (Wojtalik); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Mesholam-Gately, Sandoval, Shashidhar, Keshavan); Department of Psychiatry, Harvard Medical School, Boston (Mesholam-Gately, Sandoval, Guimond, Keshavan); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Hogarty, Greenwald, Litschge, Eack); Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Guimond); School of Social Work, University of Pittsburgh, Pittsburgh (Eack)
| | - Raquelle I Mesholam-Gately
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland (Wojtalik); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Mesholam-Gately, Sandoval, Shashidhar, Keshavan); Department of Psychiatry, Harvard Medical School, Boston (Mesholam-Gately, Sandoval, Guimond, Keshavan); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Hogarty, Greenwald, Litschge, Eack); Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Guimond); School of Social Work, University of Pittsburgh, Pittsburgh (Eack)
| | - Susan S Hogarty
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland (Wojtalik); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Mesholam-Gately, Sandoval, Shashidhar, Keshavan); Department of Psychiatry, Harvard Medical School, Boston (Mesholam-Gately, Sandoval, Guimond, Keshavan); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Hogarty, Greenwald, Litschge, Eack); Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Guimond); School of Social Work, University of Pittsburgh, Pittsburgh (Eack)
| | - Deborah P Greenwald
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland (Wojtalik); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Mesholam-Gately, Sandoval, Shashidhar, Keshavan); Department of Psychiatry, Harvard Medical School, Boston (Mesholam-Gately, Sandoval, Guimond, Keshavan); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Hogarty, Greenwald, Litschge, Eack); Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Guimond); School of Social Work, University of Pittsburgh, Pittsburgh (Eack)
| | - Maralee Y Litschge
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland (Wojtalik); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Mesholam-Gately, Sandoval, Shashidhar, Keshavan); Department of Psychiatry, Harvard Medical School, Boston (Mesholam-Gately, Sandoval, Guimond, Keshavan); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Hogarty, Greenwald, Litschge, Eack); Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Guimond); School of Social Work, University of Pittsburgh, Pittsburgh (Eack)
| | - Luis R Sandoval
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland (Wojtalik); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Mesholam-Gately, Sandoval, Shashidhar, Keshavan); Department of Psychiatry, Harvard Medical School, Boston (Mesholam-Gately, Sandoval, Guimond, Keshavan); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Hogarty, Greenwald, Litschge, Eack); Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Guimond); School of Social Work, University of Pittsburgh, Pittsburgh (Eack)
| | - Gautami Shashidhar
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland (Wojtalik); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Mesholam-Gately, Sandoval, Shashidhar, Keshavan); Department of Psychiatry, Harvard Medical School, Boston (Mesholam-Gately, Sandoval, Guimond, Keshavan); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Hogarty, Greenwald, Litschge, Eack); Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Guimond); School of Social Work, University of Pittsburgh, Pittsburgh (Eack)
| | - Synthia Guimond
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland (Wojtalik); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Mesholam-Gately, Sandoval, Shashidhar, Keshavan); Department of Psychiatry, Harvard Medical School, Boston (Mesholam-Gately, Sandoval, Guimond, Keshavan); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Hogarty, Greenwald, Litschge, Eack); Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Guimond); School of Social Work, University of Pittsburgh, Pittsburgh (Eack)
| | - Matcheri S Keshavan
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland (Wojtalik); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Mesholam-Gately, Sandoval, Shashidhar, Keshavan); Department of Psychiatry, Harvard Medical School, Boston (Mesholam-Gately, Sandoval, Guimond, Keshavan); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Hogarty, Greenwald, Litschge, Eack); Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Guimond); School of Social Work, University of Pittsburgh, Pittsburgh (Eack)
| | - Shaun M Eack
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland (Wojtalik); Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston (Mesholam-Gately, Sandoval, Shashidhar, Keshavan); Department of Psychiatry, Harvard Medical School, Boston (Mesholam-Gately, Sandoval, Guimond, Keshavan); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Hogarty, Greenwald, Litschge, Eack); Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Quebec, Canada (Guimond); School of Social Work, University of Pittsburgh, Pittsburgh (Eack)
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Bouchard M, Lecomte T, Cloutier B, Herrera-Roberge J, Potvin S. Dropout Rates in Psychosocial Interventions for People With Both Severe Mental Illness and Substance Misuse: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:842329. [PMID: 35633799 PMCID: PMC9133375 DOI: 10.3389/fpsyt.2022.842329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/07/2022] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Over the years, many psychosocial interventions for individual having both a psychotic spectrum disorder and a substance use disorder diagnoses have been developed and studied. However, there is a high dropout rate among this clinical population. OBJECTIVES This meta-analysis aims to replicate a previous meta-analysis on the effects of psychosocial treatment for dual disorders, while including and determining the dropout rates in those type of interventions. METHOD Based on a Cochrane systematic review conducted in 2019, we conducted a meta-analysis including 40 randomized clinical trials on psychosocial treatment among persons suffering from schizophrenia spectrum disorder and substance use disorder. RESULTS A dropout rate of 27,2% was obtained. Stimulants use significantly affected dropout rates. Age, gender, diagnosis, alcohol and cannabis abuse, and duration of treatment did not affect dropout rates. CONCLUSION The 27,2% rate of dropout from psychosocial treatment highlights the need to engage participants having a dual diagnosis from the start by focusing on therapeutic alliance and motivation for treatment.
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Affiliation(s)
- Marianne Bouchard
- Department of Psychology, University of Montreal, Montréal, QC, Canada
| | - Tania Lecomte
- Department of Psychology, University of Montreal, Montréal, QC, Canada.,Centre de recherche de l'Institut Universitaire en Santé mentale de Montréal, Montreal, QC, Canada
| | - Briana Cloutier
- Department of Psychology, University of Montreal, Montréal, QC, Canada
| | | | - Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé mentale de Montréal, Montreal, QC, Canada.,Department of Psychiatry, University of Montreal, Montreal, QC, Canada
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Caetano T, Pinho MS, Ramadas E, Clara C, Areosa T, Dixe MDA. Cognitive Training Effectiveness on Memory, Executive Functioning, and Processing Speed in Individuals With Substance Use Disorders: A Systematic Review. Front Psychol 2021; 12:730165. [PMID: 34489833 PMCID: PMC8418081 DOI: 10.3389/fpsyg.2021.730165] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/20/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Cerebral neuroplasticity is compromised due to substance abuse. There is damage to neuronal areas that are involved in memory and executive functioning. Treatments with worse outcomes are often associated with cognitive deficits that have resulted from substance dependence. However, there is evidence that cognitive training can lead to improvements in cognitive functions and can be useful when treating addictions. This systematic review aims to synthesize evidence on the effectiveness of cognitive training in memory, executive functioning, and processing speed in individuals with substance use disorder (SUD). Methods: The Joanna Briggs Institute's PICO strategy was used to develop this systematic literature review. Four databases were searched (PubMed, the Cochrane Library, Web of Science, and PsycINFO) to identify controlled randomized clinical studies and quasi-experimental studies, in English, Portuguese, and Spanish, from 1985 to 2019. The literature found was examined by two independent reviewers, who assessed the quality of studies that met the inclusion criteria. The Cochrane risk-of-bias tool for the randomized controlled trials and the ROBINS-I tool for non-randomized studies were used to assess the risk of bias. In data extraction, the Cochrane Handbook for Systematic Reviews was considered. Results: From a total of 470 studies, 319 were selected for analysis after the elimination of duplicates. According to the inclusion criteria defined, 26 studies were eligible and evaluated. An evaluation was performed considering the participant characteristics, countries, substance type, study and intervention details, and key findings. Of the 26 selected studies, 14 considered only alcoholics, six included participants with various SUD (alcohol and other substances), three exclusively looked into methamphetamine-consuming users and another three into opioid/methadone users. Moreover, 18 studies found some kind of cognitive improvement, with two of these reporting only marginally significant effects. One study found improvements only in measures similar to the training tasks, and two others had ambiguous results. Conclusions: The included studies revealed the benefits of cognitive training with regard to improving cognitive functions in individuals with SUD. Memory was the most scrutinized cognitive function in this type of intervention, and it is also one of the areas most affected by substance use. Systematic Review Registration: [PROSPERO], identifier [CRD42020161039].
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Affiliation(s)
- Tânia Caetano
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Center for Innovative Care and Health Technology (ciTechcare), Polytechnic of Leiria, Leiria, Portugal.,VillaRamadas International Treatment Centre, Research and Innovation Department, Leiria, Portugal
| | - Maria Salomé Pinho
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Eduardo Ramadas
- Center for Innovative Care and Health Technology (ciTechcare), Polytechnic of Leiria, Leiria, Portugal.,VillaRamadas International Treatment Centre, Research and Innovation Department, Leiria, Portugal
| | - Cátia Clara
- VillaRamadas International Treatment Centre, Research and Innovation Department, Leiria, Portugal
| | - Timóteo Areosa
- Center for Innovative Care and Health Technology (ciTechcare), Polytechnic of Leiria, Leiria, Portugal
| | - Maria Dos Anjos Dixe
- Center for Innovative Care and Health Technology (ciTechcare), Polytechnic of Leiria, Leiria, Portugal
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Mehta K, Hoadley A, Ray LA, Kiluk BD, Carroll KM, Magill M. Cognitive-Behavioral Interventions Targeting Alcohol or Other Drug Use and Co-Occurring Mental Health Disorders: A Meta-Analysis. Alcohol Alcohol 2021; 56:535-544. [PMID: 33778869 PMCID: PMC8406071 DOI: 10.1093/alcalc/agab016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS This meta-analysis reviewed 15 clinical trials (18 study sites/arms), examining the efficacy of an integrated cognitive-behavioral intervention (CBI) delivered to individuals with an alcohol or other drug use disorder and a co-occurring mental health disorder (AOD/MHD). Outcomes were alcohol or other drug use and mental health symptoms at post-treatment through follow-up. METHODS The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions. RESULTS Integrated CBI showed a small effect size for AOD (g = 0.188, P = 0.061; I2 = 86%, τ2 = 0.126, k = 18) and MHD (g = 0.169, P = 0.024; I2 = 58%, τ2 = 0.052, k = 18) outcomes, although only MHD outcomes were statistically significant. Analysis by subgroup suggested that effect magnitude varied by type of contrast condition (integrated CBI + usual care vs. usual care only; integrated CBI vs. a single-disorder intervention), follow-up time point (post-treatment vs. 3-6 months) and primary AOD/MHD diagnosis, although these sub-groups often contained significant residual heterogeneity. In a series of mixed effects, meta-regression models, demographic factors were non-significant predictors of between-study heterogeneity. For AOD outcomes, greater effects were observed in higher quality studies, but study quality was not related to effect size variability for MHD outcomes. CONCLUSIONS The current meta-analysis shows a small and variable effect for integrated CBI with the most promising effect sizes observed for integrated CBI compared with a single disorder intervention (typically an AOD-only intervention) for follow-up outcomes, and for interventions targeting alcohol use and/or post-traumatic stress disorder. Given the clinical and methodological variability within the sample, results should be considered a preliminary, but important step forward in our understanding of treatment for co-occurring AOD/MHD.
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Affiliation(s)
- Kahini Mehta
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
| | - Ariel Hoadley
- College of Public Health, Temple University, Philadelphia, PA 19122, USA
| | - Lara A Ray
- Department of Clinical Psychology, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Brian D Kiluk
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06520, USA
| | - Kathleen M Carroll
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06520, USA
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
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9
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d’Arma A, Isernia S, Di Tella S, Rovaris M, Valle A, Baglio F, Marchetti A. Social Cognition Training for Enhancing Affective and Cognitive Theory of Mind in Schizophrenia: A Systematic Review and a Meta-Analysis. THE JOURNAL OF PSYCHOLOGY 2020; 155:26-58. [DOI: 10.1080/00223980.2020.1818671] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Alessia d’Arma
- IRCCS Fondazione Don Carlo Gnocchi
- Università Cattolica del Sacro Cuore
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10
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Tatar O, Bastien G, Abdel-Baki A, Huỳnh C, Jutras-Aswad D. A systematic review of technology-based psychotherapeutic interventions for decreasing cannabis use in patients with psychosis. Psychiatry Res 2020; 288:112940. [PMID: 32344316 DOI: 10.1016/j.psychres.2020.112940] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 01/04/2023]
Abstract
Persistent use of cannabis in persons with psychosis is associated with poor symptomatic and functional outcomes and increased healthcare costs. Face-to-face psychological interventions (e.g., Cognitive Behavioral Therapy- [CBT], Motivation Enhancement Therapy- [MET]) are widely used in treating problematic cannabis use. We aimed to comprehensively review the efficacy of technology-based psychological interventions (TBPIs) in decreasing cannabis use, the design of TBPIs, and TBPI-related preferences in individuals with psychosis. For the systematic review, we searched six major databases from their inception to November 27, 2019. We included empirical articles of quantitative and qualitative methodologies related to TBPIs in individuals with psychosis and cannabis misuse and used narrative synthesis to report results. Only eight articles were found showing that technology-based motivational and psycho-education interventions and cognitive enhancement therapy were minimally efficient in achieving cannabis abstinence or decreasing frequency of use. Qualitative exploratory methods and participatory action research were used to elicit patient and clinician preferences and TBPIs were tailored accordingly to improve cannabis use related outcomes. Research on TBPIs in individuals with psychosis and cannabis misuse is in its early phases. A significant research effort is needed for the development of adapted interventions for CUD to capitalize on the potential of web-based applications.
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Affiliation(s)
- Ovidiu Tatar
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St-Denis Street, Montréal, QC, Canada, H2X 0A9; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Room S-750, Montréal, QC, Canada, H3T 1J4; Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC, Canada, H3T 1E2.
| | - Gabriel Bastien
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St-Denis Street, Montréal, QC, Canada, H2X 0A9; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Room S-750, Montréal, QC, Canada, H3T 1J4.
| | - Amal Abdel-Baki
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St-Denis Street, Montréal, QC, Canada, H2X 0A9; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Room S-750, Montréal, QC, Canada, H3T 1J4.
| | - Christophe Huỳnh
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Room S-750, Montréal, QC, Canada, H3T 1J4; Institut universitaire sur les dépendances, CIUSSS du Centre-Sud-de-l'Ile-de-Montréal, Montréal, QC, Canada; École de psychoéducation, Université de Montréal, Montréal, QC, Canada; Recherche et intervention sur les substances psychoactives - Québec (RISQ), Montréal, QC, Canada.
| | - Didier Jutras-Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St-Denis Street, Montréal, QC, Canada, H2X 0A9; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Room S-750, Montréal, QC, Canada, H3T 1J4.
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11
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Neurocognition and social cognition training as treatments for violence and aggression in people with severe mental illness. CNS Spectr 2020; 25:145-153. [PMID: 31248468 DOI: 10.1017/s1092852919001214] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Aggressive and violent behavior, including both verbal and physical aggression, have considerable adverse consequences for people with schizophrenia. There are several potential causes of violent behavior on the part of people with severe mental illness, which include intellectual impairments, cognitive and social-cognitive deficits, skills deficits, substance abuse, antisocial features, and specific psychotic features. This review explores the interventions that have been tested to this date. Computerized Cognitive Training (CCT) or Computerized Social-Cognitive Training (CSCT) have been associated with reductions in violence. Combined CCT and CSCT have been found to improve social cognition and neurocognition, as well as everyday functioning when combined with rehabilitation interventions. These interventions have been shown to reduce violence in schizophrenia patients across multiple environments, including forensic settings. The reductions in violence and aggression have manifested in various ways, including reduced violent thinking and behavior, reduced physical and violent assaults, and reduced disruptive and aggressive behaviors. Effects of cognitive training may be associated with improvements in problem-solving and the increased ability to deploy alternative strategies. The effect of social cognition training on violence reduction appears to be direct, with improvements in violence related to the extent of improvement in social cognition. There are still remaining issues to be addressed in the use of CCT and CSCT, and the benefits should not be overstated; however, the results of these interventions are very promising.
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12
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Brunette MF, Ferron JC, McGurk SR, Williams JM, Harrington A, Devitt T, Xie H. Brief, Web-Based Interventions to Motivate Smokers With Schizophrenia: Randomized Trial. JMIR Ment Health 2020; 7:e16524. [PMID: 32039811 PMCID: PMC7055792 DOI: 10.2196/16524] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In-person motivational interventions increase engagement with evidence-based cessation treatments among smokers with schizophrenia, but access to such interventions can be limited because of workforce shortages and competing demands in mental health clinics. The use of digital technology to deliver interventions can increase access, but cognitive impairments in schizophrenia may impede the use of standard digital interventions. We developed an interactive, multimedia, digital motivational decision support system for smokers with schizophrenia (Let's Talk About Smoking). We also digitalized a standard educational pamphlet from the National Cancer Institute (NCI Education). Both were tailored to reduce cognitive load during use. OBJECTIVE We conducted a randomized trial of Let's Talk About Smoking versus NCI Education to test whether the interactive motivational intervention was more effective and more appealing than the static educational intervention for increasing use of smoking cessation treatment, quit attempts, and abstinence among smokers with schizophrenia, accounting for the level of cognitive functioning. METHODS Adult smokers with schizophrenia (n=162) were enrolled in the study from 2014 to 2015, randomly assigned to intervention condition, and assessed in person at 3- and 6-month follow-ups. Interventions were delivered on a laptop computer in a single session. All participants had access to standard, community-delivered cessation treatments during follow-up. Multivariate models were used to evaluate outcomes. RESULTS Treatment initiation outcomes were not different between intervention conditions (27/84 [32%] for Let's Talk About Smoking vs 36/78 [46%] for NCI Education; odds ratio [OR] 0.71 [95% CI 0.37-1.33]); 38.9% (63/162) of participants initiated treatment. Older age (OR 1.03 [95% CI 1.00-1.07]; P=.05), higher education (OR 1.21 [95% CI 1.04-1.41]; P=.03), and fewer positive symptoms (OR 0.87 [95% CI 0.80-0.96]; P=.01) predicted cessation treatment initiation, whereas level of cognition did not. The mean satisfaction and usability index score was higher for Let's Talk About Smoking versus NCI Education (8.9 [SD 1.3] vs 8.3 [SD 2.1]; t120.7=2.0; P=.045). Quit attempts (25/84, 30% vs 36/78, 46%; estimate [Est]=-0.093, SE 0.48; P=.85) and abstinence (1/84, 1% vs 6/78, 7%; χ21=3.4; P=.07) were not significantly different between intervention conditions. Cognitive functioning at baseline (Est=1.47, SE 0.47; P=.002) and use of any behavioral or medication cessation treatment (Est=1.43, SE 0.47; P=.003) predicted quit attempts with self-reported abstinence over the 6-month follow-up. CONCLUSIONS The interactive, multimedia intervention was not more effective than the static, text-based intervention among smokers with schizophrenia. Both tailored digital interventions resulted in levels of treatment engagement and quit attempts that were similar to findings from previous studies of in-person interventions, confirming the potential role of digital interventions to educate and motivate smokers with schizophrenia to use cessation treatment and to quit smoking. These findings indicate that additional cessation treatment is needed after brief education or motivational interventions, and that cessation treatment should be adjusted for people with cognitive impairment. TRIAL REGISTRATION ClinicalTrials.gov NCT02086162; https://clinicaltrials.gov/show/NCT02086162.
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Affiliation(s)
- Mary F Brunette
- Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock, Concord, NH, United States
- Dartmouth-Hitchcock, Concord, NH, United States
| | | | | | | | - Amy Harrington
- University of Massachusetts, Worcester, MA, United States
| | | | - Haiyi Xie
- Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock, Concord, NH, United States
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13
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Hunt GE, Siegfried N, Morley K, Brooke‐Sumner C, Cleary M. Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2019; 12:CD001088. [PMID: 31829430 PMCID: PMC6906736 DOI: 10.1002/14651858.cd001088.pub4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Even low levels of substance misuse by people with a severe mental illness can have detrimental effects. OBJECTIVES To assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. SEARCH METHODS The Information Specialist of the Cochrane Schizophrenia Group (CSG) searched the CSG Trials Register (2 May 2018), which is based on regular searches of major medical and scientific databases. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing psychosocial interventions for substance misuse with standard care in people with serious mental illness. DATA COLLECTION AND ANALYSIS Review authors independently selected studies, extracted data and appraised study quality. For binary outcomes, we calculated standard estimates of risk ratio (RR) and their 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous outcomes, we calculated the mean difference (MD) between groups. Where meta-analyses were possible, we pooled data using a random-effects model. Using the GRADE approach, we identified seven patient-centred outcomes and assessed the quality of evidence for these within each comparison. MAIN RESULTS Our review now includes 41 trials with a total of 4024 participants. We have identified nine comparisons within the included trials and present a summary of our main findings for seven of these below. We were unable to summarise many findings due to skewed data or because trials did not measure the outcome of interest. In general, evidence was rated as low- or very-low quality due to high or unclear risks of bias because of poor trial methods, or inadequately reported methods, and imprecision due to small sample sizes, low event rates and wide confidence intervals. 1. Integrated models of care versus standard care (36 months) No clear differences were found between treatment groups for loss to treatment (RR 1.09, 95% CI 0.82 to 1.45; participants = 603; studies = 3; low-quality evidence), death (RR 1.18, 95% CI 0.39 to 3.57; participants = 421; studies = 2; low-quality evidence), alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low-quality evidence), substance use (drug) (RR 0.89, 95% CI 0.63 to 1.25; participants = 85; studies = 1; low-quality evidence), global assessment of functioning (GAF) scores (MD 0.40, 95% CI -2.47 to 3.27; participants = 170; studies = 1; low-quality evidence), or general life satisfaction (QOLI) scores (MD 0.10, 95% CI -0.18 to 0.38; participants = 373; studies = 2; moderate-quality evidence). 2. Non-integrated models of care versus standard care There was no clear difference between treatment groups for numbers lost to treatment at 12 months (RR 1.21, 95% CI 0.73 to 1.99; participants = 134; studies = 3; very low-quality evidence). 3. Cognitive behavioural therapy (CBT) versus standard care There was no clear difference between treatment groups for numbers lost to treatment at three months (RR 1.12, 95% CI 0.44 to 2.86; participants = 152; studies = 2; low-quality evidence), cannabis use at six months (RR 1.30, 95% CI 0.79 to 2.15; participants = 47; studies = 1; very low-quality evidence) or mental state insight (IS) scores by three months (MD 0.52, 95% CI -0.78 to 1.82; participants = 105; studies = 1; low-quality evidence). 4. Contingency management versus standard care We found no clear differences between treatment groups for numbers lost to treatment at three months (RR 1.55, 95% CI 1.13 to 2.11; participants = 255; studies = 2; moderate-quality evidence), number of stimulant positive urine tests at six months (RR 0.83, 95% CI 0.65 to 1.06; participants = 176; studies = 1) or hospitalisations (RR 0.21, 95% CI 0.05 to 0.93; participants = 176; studies = 1); both low-quality evidence. 5. Motivational interviewing (MI) versus standard care We found no clear differences between treatment groups for numbers lost to treatment at six months (RR 1.71, 95% CI 0.63 to 4.64; participants = 62; studies = 1). A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1) but not other substances (MD -0.07, 95% CI -0.56 to 0.42; participants = 89; studies = 1), and no differences were observed in mental state general severity (SCL-90-R) scores (MD -0.19, 95% CI -0.59 to 0.21; participants = 30; studies = 1). All very low-quality evidence. 6. Skills training versus standard care At 12 months, there were no clear differences between treatment groups for numbers lost to treatment (RR 1.42, 95% CI 0.20 to 10.10; participants = 122; studies = 3) or death (RR 0.15, 95% CI 0.02 to 1.42; participants = 121; studies = 1). Very low-quality, and low-quality evidence, respectively. 7. CBT + MI versus standard care At 12 months, there was no clear difference between treatment groups for numbers lost to treatment (RR 0.99, 95% CI 0.62 to 1.59; participants = 327; studies = 1; low-quality evidence), number of deaths (RR 0.60, 95% CI 0.20 to 1.76; participants = 603; studies = 4; low-quality evidence), relapse (RR 0.50, 95% CI 0.24 to 1.04; participants = 36; studies = 1; very low-quality evidence), or GAF scores (MD 1.24, 95% CI -1.86 to 4.34; participants = 445; studies = 4; very low-quality evidence). There was also no clear difference in reduction of drug use by six months (MD 0.19, 95% CI -0.22 to 0.60; participants = 119; studies = 1; low-quality evidence). AUTHORS' CONCLUSIONS We included 41 RCTs but were unable to use much data for analyses. There is currently no high-quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high-quality trials are required which address these concerns and improve the evidence in this important area.
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Affiliation(s)
- Glenn E Hunt
- The University of SydneyDiscipline of PsychiatryConcord Centre for Mental HealthHospital RoadSydneyNSWAustralia2139
| | - Nandi Siegfried
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitTybergCape TownSouth Africa
| | - Kirsten Morley
- The University of SydneyAddiction MedicineSydneyAustralia
| | - Carrie Brooke‐Sumner
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitTybergCape TownSouth Africa
| | - Michelle Cleary
- University of TasmaniaSchool of Nursing, College of Health and MedicineSydney, NSWAustralia
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14
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Lamsma J, Cahn W, Fazel S. Cognition and violent behavior in psychotic disorders: A nationwide case-control study. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100166. [PMID: 31832346 PMCID: PMC6890945 DOI: 10.1016/j.scog.2019.100166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/20/2019] [Accepted: 09/26/2019] [Indexed: 12/02/2022]
Abstract
Background The excess risk of violence in psychotic disorders may partly be explained by impairments in executive functions (EFs) and theory of mind (ToM). However, previous studies have been limited by composite measures of EFs and small samples of inpatients. Methods Data were collected for the research project Genetic Risk and Outcome of Psychosis (GROUP). Patients with psychotic disorders (N = 891) were recruited from various care settings in the Netherlands. The following neuropsychological tests were administered (targeted cognitive function in parentheses): (i) Continuous Performance Test-HQ (inhibition); (ii) Response Shifting Task (cognitive flexibility); (iii) Wechsler Adult Intelligence Scale, Third Edition (WAIS-III) Block Design subtest (fluid intelligence); (iv) Neuropsychological Assessment Battery (NAB) Mazes Test (planning); (v) Degraded Facial Affect Recognition Task (affective ToM); and (vi) Hinting Task (cognitive ToM). Lifetime violence was ascertained from medical records and patient interviews. We used analysis of covariance to compare the mean scores of violent and nonviolent patients on each test, adjusting for age and sex. Results Violent patients performed significantly worse than nonviolent patients on the WAIS-III Block Design subtest (F [1, 847] = 5.12, p = .024), NAB Mazes Test (F [1, 499] = 5.32, p = .022) and Hinting Task (F [1, 839] = 9.38, p = .002). For the other tests, the between-group differences were nonsignificant. Violent behavior explained no more than 1% of the variance in performance on each test. Conclusion Impairments in EFs and ToM are unlikely to provide useful targets for risk assessment and interventions.
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Affiliation(s)
- Jelle Lamsma
- Department of Psychiatry, University of Oxford, Oxford, UK.,Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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15
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Verdejo-Garcia A, Lorenzetti V, Manning V, Piercy H, Bruno R, Hester R, Pennington D, Tolomeo S, Arunogiri S, Bates ME, Bowden-Jones H, Campanella S, Daughters SB, Kouimtsidis C, Lubman DI, Meyerhoff DJ, Ralph A, Rezapour T, Tavakoli H, Zare-Bidoky M, Zilverstand A, Steele D, Moeller SJ, Paulus M, Baldacchino A, Ekhtiari H. A Roadmap for Integrating Neuroscience Into Addiction Treatment: A Consensus of the Neuroscience Interest Group of the International Society of Addiction Medicine. Front Psychiatry 2019; 10:877. [PMID: 31920740 PMCID: PMC6935942 DOI: 10.3389/fpsyt.2019.00877] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 11/06/2019] [Indexed: 01/01/2023] Open
Abstract
Although there is general consensus that altered brain structure and function underpins addictive disorders, clinicians working in addiction treatment rarely incorporate neuroscience-informed approaches into their practice. We recently launched the Neuroscience Interest Group within the International Society of Addiction Medicine (ISAM-NIG) to promote initiatives to bridge this gap. This article summarizes the ISAM-NIG key priorities and strategies to achieve implementation of addiction neuroscience knowledge and tools for the assessment and treatment of substance use disorders. We cover two assessment areas: cognitive assessment and neuroimaging, and two interventional areas: cognitive training/remediation and neuromodulation, where we identify key challenges and proposed solutions. We reason that incorporating cognitive assessment into clinical settings requires the identification of constructs that predict meaningful clinical outcomes. Other requirements are the development of measures that are easily-administered, reliable, and ecologically-valid. Translation of neuroimaging techniques requires the development of diagnostic and prognostic biomarkers and testing the cost-effectiveness of these biomarkers in individualized prediction algorithms for relapse prevention and treatment selection. Integration of cognitive assessments with neuroimaging can provide multilevel targets including neural, cognitive, and behavioral outcomes for neuroscience-informed interventions. Application of neuroscience-informed interventions including cognitive training/remediation and neuromodulation requires clear pathways to design treatments based on multilevel targets, additional evidence from randomized trials and subsequent clinical implementation, including evaluation of cost-effectiveness. We propose to address these challenges by promoting international collaboration between researchers and clinicians, developing harmonized protocols and data management systems, and prioritizing multi-site research that focuses on improving clinical outcomes.
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Affiliation(s)
- Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Valentina Lorenzetti
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Canberra, ACT, Australia
| | - Victoria Manning
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Hugh Piercy
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Rob Hester
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - David Pennington
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Serenella Tolomeo
- School of Medicine, University of St Andrews, Medical and Biological Science Building, North Haugh, St Andrews, United Kingdom.,Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Shalini Arunogiri
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Marsha E Bates
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, United States
| | | | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christos Kouimtsidis
- Department of Psychiatry, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, United Kingdom
| | - Dan I Lubman
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Dieter J Meyerhoff
- DVA Medical Center and Department of Radiology and Biomedical Imaging, University of California San Francisco, School of Medicine, San Francisco, CA, United States
| | - Annaketurah Ralph
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Hosna Tavakoli
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Zare-Bidoky
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.,School of Medicine, Shahid-Sadoughi University of Medical Sciences, Yazd, Iran
| | - Anna Zilverstand
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Douglas Steele
- Medical School, University of Dundee, Ninewells Hospital, Scotland, United Kingdom
| | - Scott J Moeller
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Martin Paulus
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
| | - Alex Baldacchino
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
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16
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Jones C, Hacker D, Xia J, Meaden A, Irving CB, Zhao S, Chen J, Shi C. Cognitive behavioural therapy plus standard care versus standard care for people with schizophrenia. Cochrane Database Syst Rev 2018; 12:CD007964. [PMID: 30572373 PMCID: PMC6517137 DOI: 10.1002/14651858.cd007964.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is a psychosocial treatment that aims to re-mediate distressing emotional experiences or dysfunctional behaviour by changing the way in which a person interprets and evaluates the experience or cognates on its consequence and meaning. This approach helps to link the person's feelings and patterns of thinking which underpin distress. CBT is now recommended by the National Institute for Health and Care Excellence (NICE) as an add-on treatment for people with a diagnosis of schizophrenia. This review is also part of a family of Cochrane CBT reviews for people with schizophrenia. OBJECTIVES To assess the effects of cognitive behavioural therapy added to standard care compared with standard care alone for people with schizophrenia. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (up to March 6, 2017). This register is compiled by systematic searches of major resources (including AMED, BIOSIS CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings, with no language, date, document type, or publication status limitations for inclusion of records into the register. SELECTION CRITERIA We selected all randomised controlled clinical trials (RCTs) involving people diagnosed with schizophrenia or related disorders, which compared adding CBT to standard care with standard care given alone. Outcomes of interest included relapse, rehospitalisation, mental state, adverse events, social functioning, quality of life, and satisfaction with treatment.We included studies fulfilling the predefined inclusion criteria and reporting useable data. DATA COLLECTION AND ANALYSIS We complied with the Cochrane recommended standard of conduct for data screening and collection. Where possible, we calculated relative risk (RR) and its 95% confidence interval (CI) for binary data and mean difference (MD) and its 95% confidence interval for continuous data. We assessed risk of bias for included studies and created a 'Summary of findings' table using GRADE. MAIN RESULTS This review now includes 60 trials with 5,992 participants, all comparing CBT added to standard care with standard care alone. Results for the main outcomes of interest (all long term) showed no clear difference between CBT and standard care for relapse (RR 0.78, 95% CI 0.61 to 1.00; participants = 1538; studies = 13, low-quality evidence). Two trials reported global state improvement. More participants in the CBT groups showed clinically important improvement in global state (RR 0.57, 95% CI 0.39 to 0.84; participants = 82; studies = 2 , very low-quality evidence). Five trials reported mental state improvement. No differences in mental state improvement were observed (RR 0.81, 95% CI 0.65 to 1.02; participants = 501; studies = 5, very low-quality evidence). In terms of safety, adding CBT to standard care may reduce the risk of having an adverse event (RR 0.44, 95% CI 0.27 to 0.72; participants = 146; studies = 2, very low-quality evidence) but appears to have no effect on long-term social functioning (MD 0.56, 95% CI -2.64 to 3.76; participants = 295; studies = 2, very low-quality evidence, nor on long-term quality of life (MD -3.60, 95% CI -11.32 to 4.12; participants = 71; study = 1, very low-quality evidence). It also has no effect on long-term satisfaction with treatment (measured as 'leaving the study early') (RR 0.93, 95% CI 0.77 to 1.12; participants = 1945; studies = 19, moderate-quality evidence). AUTHORS' CONCLUSIONS Relative to standard care alone, adding CBT to standard care appears to have no effect on long-term risk of relapse. A very small proportion of the available evidence indicated CBT plus standard care may improve long term global state and may reduce the risk of adverse events. Whether adding CBT to standard care leads to clinically important improvement in patients' long-term mental state, quality of life, and social function remains unclear. Satisfaction with care (measured as number of people leaving the study early) was no higher for participants receiving CBT compared to participants receiving standard care. It should be noted that although much research has been carried out in this area, the quality of evidence available is poor - mostly low or very low quality and we still cannot make firm conclusions until more high quality data are available.
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Affiliation(s)
- Christopher Jones
- University of BirminghamSchool of PsychologyEdgbastonBirminghamUKB15 2TT
| | - David Hacker
- Birmingham and Solihull Mental Health Foundation NHS TrustBirminghamUK
| | - Jun Xia
- The University of NottinghamCochrane Schizophrenia GroupTriumph RoadNottinghamUKNG7 2TU
| | - Alan Meaden
- Birmingham and Solihull Mental Health Foundation NHS TrustBirminghamUK
| | - Claire B Irving
- The University of NottinghamCochrane Schizophrenia GroupTriumph RoadNottinghamUKNG7 2TU
| | - Sai Zhao
- The Ingenuity Centre, The University of NottinghamSystematic Review Solutions LtdTriumph RoadNottinghamUKNG7 2TU
| | - Jue Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineDepartment of Clinical Psychology600 Wan Ping Nan RoadShanghaiChina200030
| | - Chunhu Shi
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthManchesterGreater ManchesterUKM13 9PL
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17
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A randomised controlled trial of manualized cognitive remediation therapy in adult obesity. Appetite 2018; 123:269-279. [DOI: 10.1016/j.appet.2017.12.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 11/20/2022]
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18
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Eack SM, Hogarty SS, Greenwald DP, Litschge MY, Porton SA, Mazefsky CA, Minshew NJ. Cognitive enhancement therapy for adult autism spectrum disorder: Results of an 18-month randomized clinical trial. Autism Res 2017; 11:519-530. [PMID: 29286586 DOI: 10.1002/aur.1913] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/31/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023]
Abstract
Cognitive remediation is a promising approach to treating core cognitive deficits in adults with autism, but rigorously controlled trials of comprehensive interventions that target both social and non-social cognition over a sufficient period of time to impact functioning are lacking. This study examined the efficacy of cognitive enhancement therapy (CET) for improving core cognitive and employment outcomes in adult autism. Verbal adult outpatients with autism spectrum disorder (N = 54) were randomized to an 18-month, single-blind trial of CET, a cognitive remediation approach that integrates computer-based neurocognitive training with group-based training in social cognition, or an active enriched supportive therapy (EST) comparison focused on psychoeducation and condition management. Primary outcomes were composite indexes of neurocognitive and social-cognitive change. Competitive employment was a secondary outcome. Intent-to-treat analyses indicated that CET produced significant differential increases in neurocognitive function relative to EST (d = .46, P = .013). Both CET and EST were associated with large social-cognitive improvements, with CET demonstrating an advantage at 9 (d = .58, P = 0.020), but not 18 months (d = .27, P = 0.298). Effects on employment indicated that participants treated with CET were significantly more likely to gain competitive employment than those in EST, OR = 6.21, P = 0.023, which was mediated by cognitive improvement. CET is a feasible and potentially effective treatment for core cognitive deficits in adult autism spectrum disorder. The treatment of cognitive impairments in this population can contribute to meaningful improvements in adult outcomes. Autism Res 2018, 11: 519-530. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY Cognitive enhancement therapy (CET), an 18-month cognitive remediation intervention designed to improve thinking and social understanding, was found to be more effective than supportive therapy at improving mental quickness, attention, and employment in adults living with autism. Social understanding was equally improved in CET and supportive therapy. Cognitive remediation interventions are feasible and may confer significant functional benefits to adults with autism.
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Affiliation(s)
- Shaun M Eack
- School of Social Work, University of Pittsburgh, Pittsburgh, PA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Susan S Hogarty
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Deborah P Greenwald
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Maralee Y Litschge
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Shannondora A Porton
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Nancy J Minshew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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19
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Abstract
Recent empirical findings from clinical and genetic studies suggest that mentalization, a key area of social cognition, is a distinct construct, although it is closely related to the neurocognitive deficits and symptoms of schizophrenia. Mentalization contributes a great deal to impaired social functioning. Current measures often display methodological problems, and many aspects should be taken into account when assessing mentalization. Moreover, advances in cognitive and affective neurosciences have led to the development of more advanced behavioral methods to assess the relationship between cognitive functions, symptoms, and social cognition based on their underlying neural mechanisms. The development of assessment tools that better examine the neural circuitry of such relationships may lead to the development of new psychosocial and pharmacological treatments.
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20
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Grant N, Lawrence M, Preti A, Wykes T, Cella M. Social cognition interventions for people with schizophrenia: a systematic review focussing on methodological quality and intervention modality. Clin Psychol Rev 2017; 56:55-64. [PMID: 28688282 DOI: 10.1016/j.cpr.2017.06.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/30/2017] [Accepted: 06/15/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND People with a diagnosis of schizophrenia have significant social and functional difficulties. Social cognition was found to influences these outcomes and in recent years interventions targeting this domain were developed. This paper reviews the existing literature on social cognition interventions for people with a diagnosis of schizophrenia focussing on: i) comparing focussed (i.e. targeting only one social cognitive domain) and global interventions and ii) studies methodological quality. METHOD Systematic search was conducted on PubMed and PsycInfo. Studies were included if they were randomised control trials, participants had a diagnosis of schizophrenia or schizoaffective disorder, and the intervention targeted at least one out of four social cognition domains (i.e. theory of mind, affect recognition, social perception and attribution bias). All papers were assessed for methodological quality. Information on the intervention, control condition, study methodology and the main findings from each study were extracted and critically summarised. RESULTS Data from 32 studies fulfilled the inclusion criteria, considering a total of 1440 participants. Taking part in social cognition interventions produced significant improvements in theory of mind and affect recognition compared to both passive and active control conditions. Results were less clear for social perception and attributional bias. Focussed and global interventions had similar results on outcomes. Overall study methodological quality was modest. There was very limited evidence showing that social cognitive intervention result in functional outcome improvement. CONCLUSIONS The evidence considered suggests that social cognition interventions may be a valuable approach for people with a diagnosis of schizophrenia. However, evidence quality is limited by measure heterogeneity, modest study methodology and short follow-up periods. The findings point to a number of recommendations for future research, including measurement standardisation, appropriately powered studies and investigation of the impact of social cognition improvements on functioning problems.
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Affiliation(s)
- Nina Grant
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Megan Lawrence
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Antonio Preti
- Genneruxi Medical Center, Center for Consultation-Liaison Psychiatry and Psychosomatics, University Hospital of Cagliari, Cagliari, Italy
| | - Til Wykes
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Matteo Cella
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
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21
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Hayes V, Demirkol A, Ridley N, Withall A, Draper B. Alcohol-related cognitive impairment: current trends and future perspectives. Neurodegener Dis Manag 2016; 6:509-523. [DOI: 10.2217/nmt-2016-0030] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Excessive alcohol use is associated with a wide range of physical, psychological and social consequences, and is responsible for a significant proportion of the burden of disease globally. An area which has received increasing interest is alcohol-related brain damage, not just because of the cost to the individual and society through resource utilization, but also because of the potential for prevention and reversibility. This paper aims to review the current literature on this subject and seeks to explore issues around diagnosis and treatment of alcohol-related brain damage.
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Affiliation(s)
- Victoria Hayes
- Drug & Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
- School of Public Health & Community Medicine, Faculty of Medicine, UNSW, Sydney, Australia
| | - Apo Demirkol
- Drug & Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
- School of Public Health & Community Medicine, Faculty of Medicine, UNSW, Sydney, Australia
| | - Nicole Ridley
- Drug & Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
| | - Adrienne Withall
- School of Public Health & Community Medicine, Faculty of Medicine, UNSW, Sydney, Australia
| | - Brian Draper
- School of Psychiatry, UNSW, Sydney, Australia
- Academic Department of Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia
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22
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Perry CJ, Lawrence AJ. Addiction, cognitive decline and therapy: seeking ways to escape a vicious cycle. GENES BRAIN AND BEHAVIOR 2016; 16:205-218. [DOI: 10.1111/gbb.12325] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/14/2016] [Accepted: 08/25/2016] [Indexed: 12/31/2022]
Affiliation(s)
- C. J. Perry
- Behavioural Neuroscience Division; The Florey Institute of Neuroscience and Mental Health; Melbourne VIC Australia
- Florey Department of Neuroscience and Mental Health; University of Melbourne; Melbourne VIC Australia
| | - A. J. Lawrence
- Behavioural Neuroscience Division; The Florey Institute of Neuroscience and Mental Health; Melbourne VIC Australia
- Florey Department of Neuroscience and Mental Health; University of Melbourne; Melbourne VIC Australia
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23
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Kiluk BD, Buck MB, Devore KA, Babuscio TA, Nich C, Carroll KM. Performance-Based Contingency Management in Cognitive Remediation Training: A Pilot Study. J Subst Abuse Treat 2016; 72:80-88. [PMID: 27590364 DOI: 10.1016/j.jsat.2016.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/12/2016] [Accepted: 08/04/2016] [Indexed: 01/13/2023]
Abstract
Impairments in attention, working memory, and executive function are common among substance users and may adversely affect SUD treatment outcomes. The ability of cognitive remediation (CR) interventions to improve these deficits is hindered in part because levels of engagement in CR training may be inadequate to achieve benefit. This pilot study aimed to increase CR engagement and improve outcome by implementing contingency management (CM) procedures that reinforce performance improvements on CR tasks. Participants were forty individuals (50% male; 65% African American) in an outpatient substance use treatment facility with mild cognitive impairment who had ≥30-days of abstinence from alcohol and drugs. They were randomized to standard (CR-S; n=21) or CM-enhanced (CR-CM; n=19) cognitive remediation training. CR consisted of 1-hour sessions, three times per week for four weeks (12 sessions). A neuropsychological assessment battery was administered prior to and after the four-week intervention. Both groups had high rates of CR session attendance (mean CR-S=11.7, CR-CM=10.9 sessions). Performance on 8 of the 9 CR tasks significantly improved over time for both conditions, with the CR-CM condition demonstrating greater improvement on a CR Sequenced Recall task [F(1,37)=5.81, p<.05]. Significant improvement was also evident on 4 of 9 neuropsychological assessment measures, with the CR-CM condition showing differential improvement on the Trail Making Test - Part B [F (1,37)=5.34, p<.05]. These findings support the feasibility of using CM procedures to enhance substance users' engagement with CR training and suggest the potential value of more research in this area.
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Affiliation(s)
- Brian D Kiluk
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA.
| | - Matthew B Buck
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Kathleen A Devore
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Theresa A Babuscio
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Charla Nich
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Kathleen M Carroll
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
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24
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Bennett ME, Bradshaw KR, Catalano LT. Treatment of substance use disorders in schizophrenia. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:377-390. [DOI: 10.1080/00952990.2016.1200592] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Melanie E. Bennett
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
- VA VISN 5 Mental Illness Research, Education, and Clinical Center, Baltimore, MD, USA
| | - Kristen R. Bradshaw
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Lauren T. Catalano
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
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25
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Eack SM, Hogarty SS, Bangalore SS, Keshavan MS, Cornelius JR. Patterns of Substance Use During Cognitive Enhancement Therapy: An 18-Month Randomized Feasibility Study. J Dual Diagn 2016; 12:74-82. [PMID: 27089154 PMCID: PMC4837677 DOI: 10.1080/15504263.2016.1145778] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Substance use problems are common among people with schizophrenia, as are significant cognitive impairments. Because of potential shared neurobiological pathways, it is possible that cognitive remediation interventions may be associated with improvements in both substance use and cognition. This study examined the impact of cognitive remediation on alcohol and cannabis use and the cognitive correlates of changes in substance use among outpatients with schizophrenia. METHODS Individuals with schizophrenia who were receiving outpatient services at a psychiatric clinic and had moderate or higher addiction severity scores (N = 31) were randomized to 18 months of cognitive enhancement therapy (n = 22) or usual care (n = 9). Cognitive enhancement therapy is a cognitive remediation approach that integrates computer-based training in attention, memory, and problem solving with a group-based social cognition curriculum. Usual care was provided to all participants and consisted of routine psychiatric care. Primary outcomes included days of alcohol and cannabis use, assessed with the Timeline Followback method every six months and modeled using penalized quasi-likelihood growth curves. RESULTS Participants were on average 38.23 (SD = 13.44) years of age, had been ill for 14.19 (SD = 11.28) years, and were mostly male (n = 22, 71%), and about half were Caucasian (n = 16, 52%). Temporal patterns of substance use days were highly variable and followed nonlinear trajectories. Intent-to-treat analyses indicated that, compared to patients only receiving usual care, those receiving cognitive enhancement therapy were significantly less likely to use alcohol (OR = .22; 95% CI: .05, .90; p = .036), but not cannabis (OR = 1.89; 95% CI: .02, 142.99; p = .774) over time, and they reduced their alcohol use at significantly accelerated rates (OR = 1.02; 95% CI: 1.01, 1.03; p = .003). Changes in cognition were variably associated with substance use outcomes, although improvements in visual learning and reasoning and problem solving were both consistently related to reduced alcohol and cannabis use. CONCLUSIONS Cognitive remediation may be effective for improving some substance use problems in schizophrenia. Visual learning and problem-solving deficits may be particularly important targets of such interventions, given their association with reduced alcohol and cannabis use. This study is registered at clinicaltrials.gov under #NCT01292577.
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Affiliation(s)
- Shaun M Eack
- a School of Social Work, University of Pittsburgh , Pittsburgh , Pennsylvania , USA.,b Department of Psychiatry , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
| | - Susan S Hogarty
- b Department of Psychiatry , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
| | - Srihari S Bangalore
- b Department of Psychiatry , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
| | - Matcheri S Keshavan
- c Department of Psychiatry , Harvard Medical School , Boston , Massachussetts , USA
| | - Jack R Cornelius
- b Department of Psychiatry , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
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26
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Wojtalik JA, Hogarty SS, Cornelius JR, Phillips ML, Keshavan MS, Newhill CE, Eack SM. Cognitive Enhancement Therapy Improves Frontolimbic Regulation of Emotion in Alcohol and/or Cannabis Misusing Schizophrenia: A Preliminary Study. Front Psychiatry 2015; 6:186. [PMID: 26793128 PMCID: PMC4709416 DOI: 10.3389/fpsyt.2015.00186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/21/2015] [Indexed: 12/17/2022] Open
Abstract
Individuals with schizophrenia who misuse substances are burdened with impairments in emotion regulation. Cognitive enhancement therapy (CET) may address these problems by enhancing prefrontal brain function. A small sample of outpatients with schizophrenia and alcohol and/or cannabis substance use problems participating in an 18-month randomized trial of CET (n = 10) or usual care (n = 4) completed posttreatment functional neuroimaging using an emotion regulation task. General linear models explored CET effects on brain activity in emotional neurocircuitry. Individuals treated with CET had significantly greater activation in broad regions of the prefrontal cortex, limbic, and striatal systems implicated in emotion regulation compared to usual care. Differential activation favoring CET in prefrontal regions and the insula mediated behavioral improvements in emotional processing. Our data lend preliminary support of CET effects on neuroplasticity in frontolimbic and striatal circuitries, which mediate emotion regulation in people with schizophrenia and comorbid substance misuse problems.
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Affiliation(s)
| | - Susan S Hogarty
- Department of Psychiatry, School of Medicine, University of Pittsburgh , Pittsburgh, PA , USA
| | - Jack R Cornelius
- Department of Psychiatry, School of Medicine, University of Pittsburgh , Pittsburgh, PA , USA
| | - Mary L Phillips
- Department of Psychiatry, School of Medicine, University of Pittsburgh , Pittsburgh, PA , USA
| | | | | | - Shaun M Eack
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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